How to address outpatient challenges | Outpatient HIM Staffing | CDI staffing

Lynn Thornton, RHIA, CCSMedPartners Education and Compliance Manager

There are many challenges facing hospitals in the provision of outpatient services. For many facilities these challenges are related to problems with the coding process.Proactively addressing these challenges by addressing all readily identifiable gaps in the coding process will lead to improved reimbursement and correct reporting. MedPartners has identified the following areas of potential improvement as a start for facilities.

1.Establish an Internal Auditing Program:Many coding problems may be resolved by establishing a quarterly internal auditing program for all service lines of HIM coding. Most importantly, the auditing program should not just be a statistical display without meaningful education for the coder. Each error should be seen as an educational opportunity and the applicable clinical, technical and regulatory guidance as well as the coding guidance for the respective classifications should be provided in the feedback to the coder.

2.Trend and Track Denials:Having a handled on why denials happen is imperative. Many times this information is not shared with the HIM Coding Leadership and it should be. This information should be analyzed for patterns and that analysis may lead to critical changes in the coding process. This analysis may also lead to identification of errant denials from payers and the facilities actions may overturn these denials resulting in the potential for increased revenue capture for future claims.

3.Establish Weekly Follow-up of all Accounts on HoldDue to HIM: Many times claims are on hold for charges not matching coding, as well as unresolved outpatient code editor(OCE)and/or national correct coding initial edits (NCCI) for procedure to procedure(PTP) and medically unlikely edits (MUE).There should never be an instance when a claim on hold for edit resolution or other corrections by the HIM Department hits the timely filing deadline and payment is lost. Reports should be run and problematicedits identified. This information should be shared with the Coding Educator.

4.Develop a Coding Education Program:Having a strong education program for HIM coders is an imperative in that it may significantly expand coder knowledge and competency. Data mining of audit information should be performed and high frequency gaps and/or errors should be identified. That information provides a gold mine of facility specific educational needs. At its bests, HIM coder education provides resources that are expansive in that they not only cover coding guidelines, but also provide clinical, technical and regulatory guidance. Images are a wonderful adjunct to education and the educators must assure all images included in their documents produced are in the Proofed and reviewed 4/12/19 vb Peer reviewed dl/vb-Mgmt approval js 4/12/19 public domain and/or creative commons. The same scrutiny must be applied to text including the AHA Coding Clinic and AMA CPT Assistant. Both of these valuable resources are copyrighted and may only be reproduced with prior permission. Having a license for use of the resources does not grant permission for reproduction of the contents.

5.Establish A Program To Promote Physician Engagement: Many times communications with physicians is ego centricto the facility in that the message is emphasizing what is “in the best interest of the facility”. Work with your physicians and help them understand why the education provided to them may also impact their professional fees for medical and surgical encounters. An important step is to have auditors with excellent strengths in professional fee coding and auditing. These staff members may establish strong bonds with physicians and assist in the development of a more collaborative relationship.

6.Implement a Coding Compliance Plan: All too often compliance for coding is not considered a mandate. A strong coding compliance plan should bring the facility in line with all regulatory requirements. The Coding Compliance program should continually be updated to reflect updates to the classifications and regulatory requirements.There should be a yearly requirement for coders to review the coding compliance program and demonstrate and understanding of the elements involved.

7.Become More Active in the Revenue Cycle Process:As a mid-revenue cycle department the Health Information Management Departments positioned to have a significant impact on the overall revenue cycle process. Department leadership should collaborate with other revenue cycle teams to determine ways to improve revenue capture and streamline processes. Identified gaps in the revenue cycle process should be shared with all team members.As a leader in the HIM Consulting Industry MedPartners is well positioned to assist facilities in meeting all of the aforementioned goals. MedPartners has the expertise to find the solutions to assist you!

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